Telephonic Nurse Case Manager

Job Description:

• Assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.
• Coordinate and implement medical case management to facilitate case closure
• Timely and comprehensive communication with employers, adjusters and the injured workers.
• Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care
• Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure
• Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction
• Acquire and maintain nursing licensure for all jurisdictions as business needs require
• Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services
• Document activities and case progress using appropriate methods and tools following best practices for quality improvement
• Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work.
• Engage and participate in special projects as assigned by case management leadership team
• Occasionally attend on site meetings and professional programs
• Foster a teamwork environment
• Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status.
• Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed.
• Obtain case management professional certification (CCM) within 2 years of hire date
• Earn Continuing Education Units to maintain certifications and licensures

Requirements:

• Minimum 2 years of experience in workers compensation insurance and medical case management preferred
• Minimum of 4 years medical/surgical clinical experience required
• Exhibit strong communication skills, professionalism, flexibility and adaptability
• Possess working knowledge of medical and vocational resources available to the Workers’ Compensation industry
• Demonstrate evidence of self-motivation and the ability to perform case management duties independently
• Demonstrate evidence of computer and technology skills
• Oral and written fluency in both Spanish and English a plus.
• Graduate of an accredited school of nursing and possess a current RN license. RN California license strongly preferred, CCM preferred, Bachelor of Nursing preferred

Benefits:

• Health
• Dental
• Vision
• Life
• Disability
• Wellness
• Paid Time Off
• 401(k) and Profit-Sharing plans

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